Bickerstaff’s syndrome presenting with coma, tetraplegia and blindness

Bickerstaff’s brainstem encephalitis (Bickerstaff, Br Med J 1951, 2: 77-81) is characterized by the presence of ataxia, ophthalmoplegia, weakness with areflexia, drowsiness, pyramidal signs and sensory symptoms. The diagnosis is now based on MRI and the presence of IgG anti-ganglioside antibodies to GQ1b. Optimal treatment is not well defined.

Bickerstaff’s syndrome has been reported mainly in the Japanese. In this case-report a 39 year-old man from Laos showed hyperintense MRI signal in the brainstem.The GQ1b antibodies were positive. He recovered well. The authors emphasise the fact that the features of Bickerstaff’s, Miller Fisher’s and Guillain-Barré’s syndromes are similar. A good prognosis and the presence of GQ1b antibodies are also shared features of all 3 syndromes.

15 references.